Ob Exam 2

Front 1

Fetal 2 neonatal circulation changes

Back 1

Umbilical cord clamps with first breath foraminal ovallie closes within minutes with another breath ductus venosus closes and became ligament ductus arteriosus closes within 10 to 15 hours after birth

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Normal heart rate for newborn is

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120 to 160

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Surfactant is

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Is surface tension reduction lipoprotein found in the newborn's lungs that prevents alveolar collapse at the end of expiration and loss of lung volume and is needed to stabilize the baby's chest wall

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Normal respiration in the newborn is

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30 to 60 with short. Of apnea less than 15 seconds

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What is periodic breathing

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The cessation of breathing that last 5 to 10 seconds without changes in color or heart rate

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Conduction

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Transferring heat from one object to another when two objects are in direct contact such as cold hand use warm cloth or blanket to cover every cold surface touching the baby or place the baby on skin-to-skin with the mother

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Convection

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The flow of heat from the body surface to cooler surrounding air or two are circulating over the body surface examples make sure to transfer baby in a warmer don't allow cold air to come in contact with a baby

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Evaporation

Back 8

The loss of heat when a liquid is converted to a vapor such as from skin and respiration or sweating example is bathing the baby or drying the baby after bath

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Radiation

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Loss of body heat to cooler Solid Surfaces that are in proximity but not in direct contact with the newborn example is putting baby near a cold window keep baby away from outside walls cold windows in air conditioners

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thermoregulation

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The process of maintaining the balance between heat loss and heat production in order to maintain its core internal temperature it is

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Characteristics that predispose heat loss are

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Thin skin lack of shivering ability limit stores of metabolic substances such as glucose glycogen and fat limited use of muscles large body surface areas lack of subcutaneous fat little ability to conserve Heat no ability to adjust their own clothing or blankets and inability to communicate

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Effects of cold stress in the newborns Brown fat metabolism

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The newborn first experiences and increase and norepinephrine and response to a cold environment this and then influences the triglycerides to stimulate Brown fat metabolism

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The main source of energy for newborn is

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Glucose and early feeding is recommended

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Jaundice

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Yellowing of the skin sclera and mucous membrane it is visible as a result of elevated bilirubin

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Extreme elevated bilirubin in the blood can cause

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Bilirubin encephalopathy

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Risk factors for jaundice are

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Fetal maternal blood group incompatibility prematurity asphyxia at Birth an insufficient intake of milk during breastfeeding drugs such as diazepam Valium oxytocin maternal trauma during birth resulting in several tell edema cute sadness bruising from birth trauma polycythemia preview siblings with hyperbilirubinemia

Front 17

Causes of jaundice are

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Bilirubin overproduction drugs trauma at Birth polycythemia delayed cord clamping breast milk jaundice decrease bilirubin conjugation hypothyroidism and breastfeeding impaired bilirubin excretion binary sepsis hepatitis chromosomal abnormality Turner syndrome try tsunamis 18 + 21 aspirin Tylenol sulfa alcohol steroids antibiotics

Front 18

Gastrointestinal system

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Stomach is pretty small do not give too much feeding

Front 19

Meconium should be passed Within

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12 to 24 hours and it's semi sterile

Hint 19

Newborn that are fed early pasta sooner which helps to reduce bilirubin build up

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Renal system

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I want to see them void and not to give too much medication

Front 21

Immunoglobulin G that's what

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Crosses the placenta while in utero it is the major immunoglobulin and the most abundant

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IGA is

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The second most abundant immunoglobulin in the serum it does not cross the placenta and maximum level or reach during childhood it protects the mucous membrane from viruses and bacteria predominantly found in the GI wall a respiratory tract tears saliva colostrum and breastmilk

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IGM is

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Bloodborne immunoglobulin

Front 24

In the first period Of reactivity

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Begins at Birth and mail us from 30 minutes to 2 hours newborn is alert and moving in may appear hungry myoclonic movement of the eyes spontaneous more reflects sucking motion chewing routing and fine Tremors of the extremity this. Allow parents to interact with the newborn and to enjoy close contact with their new baby

Front 25

Period Of decreased responsiveness

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From 30 to 120 Minutes newborn into second stage of transition sleep. Or a decrease in activity movements or less jerky and less frequent heart and respiratory rate decline as the no point enters the Sleep face

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Second period Of reactivity

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Second period begin as the newborn awakens and shows an interest and environment stimuli this. May last two to eight hours in the normal newborn heart and respiration increase peristalsis increase infant me pass meconium or avoid doing this.

Hint 26

Teaching about feeding positioning for feeding and diaper change techniques can be performed during this time

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Orientation

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Response of newborn to stimuli they become more alert when they sense a new stimulus in their environment they prefer human face and bright shiny objects

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Habituation

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Newborns ability to process and respond to visual and auditory stimuli it is a measure of how well an appropriately and infant respond to the environment it is also the ability to block out external stimuli after the newborn has become accustomed to the activity

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apgar score

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It is used to evaluate a newborn physical condition at one minute and five minutes after birth its focus is on appearance color pulse heart rate Grimace reflex irritability activity muscle tone

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Apgar score parameter

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Normal newborn should be 8 to 10 and no intervention is needed score of 4 to 7 is moderate difficulty in score of zero to three is severe distress in adjusting to extrauterine life

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Newborn vital signs

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Temp 97.3 to 99.5 heart rate 120 to 160 respiration 30 to 60 blood pressure 50 to 75 systolic and 30 to 45 diastolic

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Neuromuscular maturity focuses on

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Posture Square window wrist arm recoil popliteal angle scarf sign heel to ear

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Vitamin K is given to the newborn for

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To promote blood clotting prevents vitamin K deficiency bleeding it's administered within 1 to 2 hours of birth given 90 degree angle used 25 gauge 5/8 in Needle inject slowly given in the vastus lateralis giving I am

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Erythromycin ophthalmic ointment

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Provides bactericidal and bacteriostatic action to prevent gonorrhea or chlamydia also prevent abdominal near Taryn the alert for chemical conjunctivitis for 1 to 2 days wear gloves and place on the inner canthus to the outer canthus of each eye do not touch tip of the eye wipe off excess after 1 minute

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Vernix

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White creamy cheesy Stuff on baby

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Melia

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Multiple pearly white or pale yellow on open sebaceous gland frequently found on a new born's knows or forehead they should disappear within 2 to 4 weeks

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Epstein Pearl

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Pearl white or pale yellow an open sebaceous and the baby's mouth and gums

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Mongolian spots

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Benign blue or purple Spa churches that appear solitary on the lower back and buttocks of newborn but may occur as multiple over legs and shoulders mostly and African American Asian Hispanic and Italian newborns but can be in any dark skin newborn of all Races will disappear within the first four years

Front 39

Erythema toxicum

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Newborn rash a benign idiopathic generalized rash that occurs in up to 70% of all newborns during the first week of life it consists of small papules or pustules on the skin resembling flea bites it is often mistaken for Staphylococcus pustules commonly on the face chest and back chief of characteristic is that lack pigment caused by newborn a synovial reacting to the environment

Front 40

Stop bites

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Salmon patches are superficial vascular areas found on the nape of the neck on the eyelids and between the eyes and upper lip they are caused by concentration of immature blood vessels and almost visible when the newborn is crying Disappear Completely within the first year

Front 41

Molding

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Elongated shaping of the fetal head to accommodate Passage through the birth canal occurs during vaginal birth from a Vertex position atypical resolve within a week after birth without intervention

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Caput succedaneum

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Localized edema on the scalp that occurs from the pressure of the birth process it is commonly observed after prolonged labor clinically it appears as a poorly demarcated soft tissue swelling that crosses suture line pitting edema in overlying petechiae and ecchymosis are noted the swelling will gradually dissipate in about 3 days without any treatment may also happen if vacuum delivered

Front 43

Cephalohematoma

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A localized subperiosteal collection of blood of the skull which is always confined by one cranial bone it is due to pressure on the head and disruption of the vessels do during birth occurs after prolonged labor using low forceps or vacuum the features include well demarcated often fluctuate swelling with no overlying skin discoloration the swelling does not cross suture lines and is firmer to the touch then an edematous area aspiration is not required due to infection hyperbilirubinemia occurs following the breakdown of the RBC within the hematoma it usually disappears on the second or third day after birth

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Large fontanelles

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More than 6 cm and the interior and more than one centimeter diameter in the posterior possibly associated with malnutrition hydrocephalus congenital hypothyroidism Trisomy 13 18 and 21 or osteogenesis imperfecta

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Small or closed fontanelles

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Smaller than normal interior and posterior diameters or fontanel's that are closed at Birth craniosynostosis and abnormal brain development are associated with a small functional or early fontanelle closure associated with microcephaly

Front 46

Eyes of a newborn

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Inspect eyelids lashes conjunctiva vs. Sclera Iris and pupils for position color size and movement edema of the eyelids and subconjunctival hemorrhages due to pressure during birth I should be clear symmetrically place test blank reflex by beginning object close to the eye newborn should respond quickly by blinking newborns pupillary reflex should be equal round and reactive to light bilaterally gays he or she should be able to track objects to the midline movement baby uncoordinated doing the first few weeks someday have transient strabismus a deviation of wondering of the eyes independently and searching nystagmus involuntary repetitive eyes movement those are caused by Immature muscular control they are normal for the first three to six months of age retroflex should be seen bilaterally the red reflex normally shows no dullness or irregularities chemical conjunctivitis, likely occur within 24 hours of installation of the eye prophylaxis this is late edema which cell discharge from both eyes usually is resolved within 48 Hours of treatment without treatment

Front 47

Ears of a newborn

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Inspect for size shape skin condition placement a lot of cartilage patency of the auditory canal it should be soft and pliable and should require quickly and easily when folded and released should be aligned with outer canthus of the eyes low-set ears and abnormally shaped ears or characteristic of many syndromes in genetics such as Trisomy 13 and 18 ear canal will be filled with amniotic fluids and vernix which would make visualization of the tympanic membrane difficult hearing screening is required

Front 48

Causes of hearing loss

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Can be conductive or sensorineural or Central risk factors are cytomegalovirus infection and preterm birth necessitating estate and the new natal Intensive Care Unit observe newborn's response to noise and conversations the newborn typically turns towards the noise and startles with loud noise

Front 49

Male genitalia

Back 49

Inspect penis and scrotum Indus circumcised male norbord the Glen should be smooth with creative Center at the tip of the penis it will appear reading until it heals for the uncircumcised male the foreskin should be covered with the glands check for position of the urinary meatus it should be in the midline at the Glens tip it if it is on the ventral surface of the penis the condition is term hypospadias if it is on the dorsal surface of the penis it is termed epispadias in any case circumcision should be avoided until further evaluation inspector I'm size symmetry color presence of rugae and location of testes the scrotum usually appears relatively large with well for Andrew gate and that should cover the scrotal sac they should not be bulging edema or discoloration poppy scrotum for evidence of testes which should be and scrotal Sac the tested should feel firm and smooth and should be of equal size on both sides it's off the scrotal sac and the term newborn undescended testes cryptotrader ISM might be palpated in the inguinal canal and preterm infants they can be unilateral or bilateral

Front 50

Female genitalia

Back 50

Inspect external genitalia do you read throw me a this is located below the clitoris and the midnight in contrast to the male genitalia of the female genitalia will be engorged the labia majora and minora may both be in Dimmitt is the labia majora is large and covers the labia minora the clitoris is large and the high many stick these findings or do to the maternal hormones estrogen and progesterone vagina no discharge composed of mucus mixed with bloody may also be present during the first few weeks of life this discharge is called pseudomenstruation requires no treatment variation in female newborns may include labial bulge which might indicate inguinal hernia ambiguous genitalia a rectovaginal fistula with feces present the vagina and M perforated hymen

Front 51

Male and female anus

Back 51

Inspect bowls for position and patency passage of meconium indicates patency if meconium is not passed a lubricated rectal thermometer can be inserted or a digital examination can be performed to determine patency abnormal findings would include anal fissures of fistula and no meconium pass within 24 hours after birth

Front 52

Newborn assessment summary

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Head circumference 33 to 37 CM chest circumference 32 33 cm weight 2500 of 4000 5.5 to 8.5 lb lengths 45 to 55 cm 17 to 21

Front 53

Newborn skin

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Should be smooth flexible good skin turgor well-hydrated warm abnormal jaundice acrocyanosis milia Mongolian spots stork bites

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newborn head

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Normal varies with age gender and ethnicity abnormal microcephaly macrocephaly in large fontanelles

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Newborn face

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Normal full cheeks facial features symmetric abnormal facial nerve paralysis nevus flammeus nevus vasculosus

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Newborn nose

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Normal small placement in the midline and now the ability to smell abnormal malformation or blockage

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Newborn mouth

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Normal a line and midline symmetric and text soft and hard palate abnormal Epstein pearls erupted precocious teeth thrush

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Newborn's neck

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Normal short creased moves freely baby holds head and midline abnormal restricted movement clavicular fractures

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Newborn eyes

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Normal clear and symmetrically place on face online with ears abnormal chemical conjunctivitis subcon judicial hemorrhage

Front 60

Ears newborn

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Normal soft and pliable with quick recoil when folded and released abnormal low-set ears hearing loss

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Newborn chest

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Normal round symmetric smaller than head abnormal nipple engorgement whitish discharge

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Abdomen newborn

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Normal protuberant Contour soft three vessels in umbilical cord abnormal distended only 2 vessels in umbilical cord

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Genitals

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Normal male smoothie cleanse me it is centered at tip of penis female swollen genitals as a result of maternal estrogen abnormal edematous scrotum in males and vaginal discharge and female

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Extremities newborn

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Normal symmetric with free movement abnormal congenital hip dislocation turfed or dimple on spine

Front 65

Newborn reflexes appearance and disappearance

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Blinking newborn persist into adulthood Moro from newborn to 3 to 6 months grasp from newborn to 3 to 4 months stepping birth to one or two months tonic neck newborn 3 to 4 months sneeze newborn persist into adulthood routing birth 4 to 6 months gag reflex newborn persist to adulthood cough reflex newborn persist into adulthood the Babinski sign newborn the 12 months

Front 66

Bathing and hygiene of the newborn

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Done primarily for aesthetic reasons and is postponed until thermal in cardiorespiratory is ensured important steps wear gloves bathe quickly drying as you go to prevent heat loss

Front 67

Teaching guidelines for bathing a newborn

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One room with flat surface gather all supplies before begin never leave the newborn alone or unattended undressed a newborn down to shirt and diaper always support the newborn's head and neck when moving or positioning him or her place a blanket or towel underneath the newborns for warmth and comfort progress from cleanliness to dirtiest area

Front 68

Cord care

Back 68

Umbilical cord begins trying within hours after birth and is shriveled and black and by the second or third day within 7 to 10 days a sloth off in the umbilicus hill during this transition frequent assessment of the area are necessary to detect any bleeding or signs of infection to protect the cord area during each diaper change apply the appropriate agent so just triple dye alcohol or antimicrobial agent

Front 69

Teaching guidelines for umbilical cord care

Back 69

Observe from bleeding redness drainage or foul odor from the court stop avoid tub bath until court has fallen off expose the cord stump to the air as much as possible full diapers below the level of the court to prevent contamination of the site and to promote air drying observe the court stop which will change color from yellow to Brown to Black this is normal never pulled the cord or attempt to loosen it it will fall off naturally

Front 70

circumcision benefits

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Urinary tract infection sexual transmitted infections are less common and penile cancer are slightly lower rate

Front 71

Circumcision pre-op

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Infant is at least 12 hours old or older has received standard vitamin K has voided at least once has not eaten for at least one hour written parental consent correct identification

Front 72

Circumcision post-op

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Excessive bleeding every 30 minutes for at least 2 hours document first void to evaluate for urinary obstruction or edema squeeze soapy water over the area at Daly and then rinse with warm water that dry up like a small amount of petroleum jelly with every diaper change if the plastic bubble was used clean with mild soap and water if other techniques were use fasting the diaper Loosely over the penis and avoid placing the newborn on his abdomen to prevent friction if plastibell was used it will fall off by itself in about a week do not pull it off sooner check daily for any foul smelling drainage bleeding or unusual swelling if uncircumcised wash the penis with mild soap and water after each diaper change and do not force the foreskin back you will retract normally overtime

Front 73

Promoting newborn sleep

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Back to sleep they sleep for two to four hours at a time but do not sleep through the night because their stomach pass it is too small to go long periods without nourishment they sleep up to 15 hours a day

Front 74

PKU testing

Back 74

Newborns need to ingest milk or formula to elevate femalelalamine levels for the screening to be accurate should not perform before 24 hours of age it is done for autosomal recessive inherited deficiency in one of the enzyme necessary for metabolism of phenylalanine to tyrosine essential amino acids found in most food

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Effect if PKU is not treated

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Irritability vomiting protein feedings and a musty odor to the skin or body secretions of the newborn if not treated mental and motor retardation seizures microcephaly and poor growth and development

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Treatment for PKU

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Lifetime died of food low in protein and monitoring of blood levels special newborn formula is available Phoenix and Loaf N A lot

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Transient tachypnea of the newborn

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Abuse soon after birth occurs when the fetal liquid in the lungs is removed slowly or incompletely can be due to lack of thoracic squeezing that occurs during the Cesarean birth or diminished respiration effort if the mother is the central nervous system depressant medication prolonged labor microsomia of the fetus and maternal asthma also have been associated with this condition vaginal birth appears to be protective against transient tachypnea of the newborn

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Signs of transient tachypnea of the newborn

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Retractions expiratory grunting cyanosis and is relieved by low-dose oxygen therapy matamata respiration distress typically is present at birth or within 6 hours of birth transient tachypnea of the newborn is generally a self-limited disorder without significant morbidity unresolved over a 24 hour to 72 hour.

Front 79

Nursing interventions for transient tachypnea of the newborn

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Give oxygen and show warmth observe respiratory status frequently allowed time for the pulmonary capillaries in the lymphatic to remove two remaining fluid

Front 80

Physiology jaundice

Back 80

Very common in newborn demonstrating yellowish skin mucous membrane and sclera within the first 3 days of life it's a visible manifestation of hyperbilirubinemia result from the position of conjugated bilirubin pigment in the skin and mucous membrane factors contribute to it include increased bilirubin load because of polycythemia is short and shorten erythrocyte immature hepatic uptake and conjugation treatment is phototherapy. Feed baby 8 to 12 times do not give water

Front 81

Care of a newborn receiving phototherapy for jaundice

Back 81

Closely monitor body temperature and fluid and electrolyte balance document frequency character and consistency of stool monitor hydration status weight specific gravity of urine a urine output turn frequently to increase the infant's skin exposure to phototherapy observe Skin Integrity as a result of exposure to diarrhea and phototherapy lights provide eye protection to prevent corneal injury related to phototherapy exposure encourage parents to participate in their newborns care to prevent parent infant separation

Front 82

Breastfeeding positioning

Back 82

Football hold the mother holds the infant's back and shoulders in her palm and Tux the infant under her arm ear shoulder and hip in a straight line mother supports breast with her hand cradling position most commonly used mother holds the baby in the crook of her arm with the infant facing the mother the mother supports the breast with her opposite hand across the lap position mother places of pillow across the lab with the infant facing the mother the mother support the infant's back and shoulders with her poem to support the breast sideline position the mother lies on her side with a pillow supporting her back and another pillow supporting the newborn in the front

Front 83

Teaching guidelines for breastfeeding

Back 83

Set aside quiet place where you can relax sit in a comfortable chair a rocking chair listen to soothing music and sip in a Trish's drink initially nurse the newborn every few hours to stimulate the milk production watch for signals from the infant to indicate that he or she is hungry stimulate the rooting reflex look for signs indicating that the newborn has launched correctly hold a newborn closely facing the breast nursing infant on demand not on Rigid schedule feed every 2 to 3 hours with any 24-hour period for a total of eight to twelve feedings alternate the breast you offer the first identify with a safety pin and bra Veria position for each feeding to empty breast and reduce soreness look for signs that the newborn is getting enough milk such as 6 wet diapers or two to five loose yellow stools wake up the new one if he or she has Nurse less than 5 minutes for unwrapping by unwrapping him or her before removing the baby from the breast break the reference section by inserting a finger broke the infant to release Air of what supplemental formula avoid drinking alcohol or caffeine do not smoke while feeding always wash your hands before expressing or handling milk to store wear nursing bras

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Hep B newborns first immunization

Back 84

Given soon after birth the first dose can also be given by Age 2 months if the mother is HB negative is the mother is hpv-positive than the newborn should receive Hep B vaccine and Hep B immunoglobulin within 12 hours of birth